Provider Demographics
NPI:1508438730
Name:DANIEL, ERIC JEFFERY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JEFFERY
Last Name:DANIEL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6645 N SOCRUM LOOP RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-4182
Mailing Address - Country:US
Mailing Address - Phone:863-853-3000
Mailing Address - Fax:863-859-7640
Practice Address - Street 1:6645 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4182
Practice Address - Country:US
Practice Address - Phone:863-393-6913
Practice Address - Fax:863-859-7640
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13637111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor